Variant RHD alleles and Rh immunization in patients with sickle cell disease.
Variant RHD alleles and Rh immunization in patients with sickle cell disease.
复制标题
镰状细胞病患者的变异 RHD 等位基因和 Rh 免疫。
DOI：
10.1111/bjh.18774
复制
发表时间：
2023
影响因子：
6.5
通讯作者：
Chou,StellaT
中科院分区：
文献类型：
--
作者：
Takasaki,Kaoru;Friedman,DavidF;Uter,Stacey;Vege,Sunitha;Westhoff,ConnieM;Chou,StellaT
尽管进行了血清学 Rh 匹配的红细胞输注，但患者和捐赠者之间的 RH 多样性仍有助于 Rh 免疫。抗 D 抗体可出现在具有编码部分 D 抗原的 RHD 变异的 D+ 患者中。据报道，传统 RHD 患者主要接受来自经常患有变异 RHD 的黑人捐献者的单位输血，抗 D 抗体也已被报道。我们报告了 690 名 D+ 输血患有镰状细胞病的个体中有 48 种抗 D 抗体，此处分类为表达常规 D、部分 D 或由 RHD*DAU0 编码的 D 抗原。具有部分 D 的个体中，抗 D 形成的比例较高，在接触较少的 D+ 单位后发生，并且比其他类别的个体保持可检测的时间更长。在所有抗 D 抗体中，有 13 例具有输血红细胞存活率较差的临床或实验室证据。大多数患有抗 D 抗体的个体都长期输血，其中 32 名患有传统 RHD 的患者在抗 D 抗体后平均每年需要 62 个 D− 单位。我们的研究结果表明，部分 D 患者可能受益于预防性 D− 或 RH 基因型匹配输血，以预防抗 D 抗体。未来的研究应该调查 RH 基因型匹配的输血是否可以改善黑人捐赠者宝贵捐赠的使用，减少 D 免疫接种，并尽量减少向具有传统 RHD 或 DAU0 等位基因的 D+ 个体输注 D− 单位。
RHdiversity among patients and donors contributes to Rh immunization despite serologic Rh‐matched red cell transfusions. Anti‐D can occur in D+ patients withRHDvariants that encode partial D antigens. Anti‐D has also been reported in patients with conventionalRHDtransfused primarily with units from Black donors who frequently have variantRHD. We report 48 anti‐D in 690 D+ transfused individuals with sickle cell disease, categorized here as expressing conventional D, partial D or D antigen encoded byRHD*DAU0. Anti‐D formed in a greater proportion of individuals with partial D, occurred after fewer D+ unit exposures, and remained detectable for longer than for those in the other categories. Among all anti‐D, 13 had clinical or laboratory evidence of poor transfused red cell survival. Most individuals with anti‐D were chronically transfused, including 32 with conventionalRHDwho required an average of 62 D− units/year following anti‐D. Our findings suggest that patients with partial D may benefit from prophylactic D− orRHgenotype‐matched transfusions to prevent anti‐D. Future studies should investigate whetherRHgenotype‐matched transfusions can improve use of valuable donations from Black donors, reduce D immunization and minimize transfusion of D− units to D+ individuals with conventionalRHDorDAU0alleles.